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Heaving apical impulse

Apex beat is forceful and well sustained
It is forceful and well sustained due to systolic overload of ventricle.
It is well sustained due to obstruction of left ventricular outflow.
There is sustained lift of palpating finger above the plane of adjoining ribs
Mechanism  of heaving apex beat
This is due to pressure overload of Leftventricle ,force and duration of left ventricular contraction is increased
Causes of heaving apex are 
  • Aortic stenosis
  • Systemic hypertension
  • Hypertrophic obstructive cardiomyopathy HOCM.